Provider Demographics
NPI:1639189954
Name:CHISOM MEDICAL GROUP LLC.
Entity Type:Organization
Organization Name:CHISOM MEDICAL GROUP LLC.
Other - Org Name:CY-FAIR MEDICAL SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:SYLVESTER
Authorized Official - Middle Name:CHUKWUEMEKA
Authorized Official - Last Name:OGUH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-454-3878
Mailing Address - Street 1:10511 JONES RD
Mailing Address - Street 2:E
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77065-4291
Mailing Address - Country:US
Mailing Address - Phone:281-469-2300
Mailing Address - Fax:281-469-2315
Practice Address - Street 1:10511 JONES RD
Practice Address - Street 2:E
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77065-4291
Practice Address - Country:US
Practice Address - Phone:281-469-2300
Practice Address - Fax:281-469-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0089455332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies